Provider Demographics
NPI:1477823136
Name:CHRISTIAN THERAPY AND MEDIATION SERVICES, LLC
Entity Type:Organization
Organization Name:CHRISTIAN THERAPY AND MEDIATION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DWAIN
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:DMIN, LCMFT, LCAC
Authorized Official - Phone:620-662-1283
Mailing Address - Street 1:4290 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-2223
Mailing Address - Country:US
Mailing Address - Phone:620-662-1283
Mailing Address - Fax:620-662-1347
Practice Address - Street 1:4290 N MONROE ST
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-2223
Practice Address - Country:US
Practice Address - Phone:620-662-1283
Practice Address - Fax:620-662-1347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty